Parent/​Guardian #1 Name *

First Name

Last Name

Phone *

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/​Guardian #2 Name

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact (If parent is unreachable) *

First Name

Last Name

Phone

(###)

###

####

Student *

First Name

Last Name

Birth Date *

MM

DD

YYYY

Choose Week(s): *

Camp has $30/Day option available, email fellowshipcom@gmail.com for assistance.

Week 1: June 12-16, 2023 (7th-9th grade only) - $150.00

Week 2: June 19-June 23, 2023 (7th-9th grade only) - $150.00

Week 3: June 16-30, 2023 (3rd-7th grade only) - $150.00

Would you attend July summer camp?